Provider Demographics
NPI:1902818792
Name:FRAZIER, JODY A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:A
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:A
Other - Last Name:JOSWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2202 HARLEM RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-636-6125
Practice Address - Street 1:2202 HARLEM RD STE 200
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-636-6125
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041380384163W00000X
WI76911-30163W00000X
WI76911367500000X
IL209-007826367500000X
IL209007826367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43358900Medicaid
WI43358900Medicaid
R70622Medicare UPIN